Psychiatry's scientific reboot gets under way

I thought this was quite an interesting read, will be great if they make some good progress in this direction.

IMAGINE you are a doctor before the advent of modern medical tests and your patient is gasping for breath. Is it asthma, a chest injury, or are they having a heart-attack? You don't know and have no idea how best to help them.

Some would argue that's what it's like for doctors trying to diagnose mental health problems today. There are no blood tests or brain scans for mental illnesses so diagnoses are subjective and unreliable.

It is equally important to challenge the presumption that mental illness even exists. We need objective scientific investigation, where-ever it may go.

Brain illnesses would be due to the altered physiology of the brain, right down to the molecular level including gene expression, toxicity, etc.

The place where mental illness, per se, can hide is in aberrant belief systems. I am not talking about the false beliefs causing disease claim, but the strange notions that people have. Like walking under ladders is unlucky. Like exists in modern cults where people are brainwashed. Like any extreme viewpoint that exists in society, if it is not also backed up by evidence or sound reason.

Yet I would hesitate to call these mental illness, and would be very reluctant to pursue treatment on them unless the patient had serious problems and sought help. Where would it stop? I support democracy. Could that be considered an aberrant belief system? Would it be an exception because its a societal norm? As soon as you define this by societal norms, you create social schism, and a basis for persecution of people based on their beliefs. This is not a good thing.

Even addictions I would call a brain problem. The problem is in the brain, and while thoughts may contribute to the process they are not the cause. The same occurs with phobia.

Now mass panic might be an interesting grey area. I think it would qualify under aberrant beliefs, not brain problems, but I suspect it might be better as a distinct category all on its own.

Nobody doubts that thoughts can alter the expression of disease, and risk of disease (largely by altering behaviour or increasing stress). The notion that they cause disease is quaint, unproven, and very outdated. In the early days of psychosomatic psychiatry there was the notion that thoughts can alter a disease, and that this needed to be investigated. That was what psychosomatic psychiatry was. It was Charcot and later Freud who changed that, and to this day their ideas remain unproven.

Even PTSD, created as a result of intense traumatic experience, is a brain disorder. The memory system is fried, rewired. Its a hardware problem in my view, that has thoughts as output that are problematic, and can be influenced by thoughts and other events, but is itself due to brain dysfunction.

If psycho-psychiatrists are happy they are right, they should not be worried about biopsychiatry. If the biopsychosocial proponents really believe in their ideas, then they shouldn't be worried either.

Don't mistake my position, biopsychiatry has had more than its share of failures too. However there is enormous amounts of research on neuroscience that could do with more direct investigation with respect to what we call mental disorders. So its a valid research direction.